Results 1 to 7 of 7

Rule Out/ Suspected DX

  1. #1
    Default Rule Out/ Suspected DX
    Exam Training Packages
    When billing for a physician's in patient evaluation and management services, can you use rule out or suspected diagnoses codes for the visit? I am getting conflicting reports. It is my understanding that you code to the highest degree of certainty. However, there seems to be some variation when it comes to billing in the in patient setting. Can someone offer further clarification?
    Last edited by heatherwinters; 02-03-2009 at 12:49 PM.
    Heather Winters, CPC, CFPC

  2. #2
    Location
    North Carolina
    Posts
    3,126
    Default
    Do not code from "probable", "suspected," "questionable," "rule out," or "working diagnosis" or other similar terms indicating uncertainty. If a definitive diagnosis is not known upon the completion of the service, the diagnosis should be listed as the symptoms, signs, abnormal test results, or other reason for the visit.

    I just noticed the word inpatient...I'm mostly provider based but, correct me if I'm wrong... In the inpatient setting, if a diagnosis documented at the time of discharge is qualified as "probable," "suspected," "likely," "questionable," "possible," or "rule out," the condition should be coded as if it existed or was established. The basis for this guideline are the diagnostic workup, arrangements for further workup or observation, and initial therapeutic approach that correspond most closely with the established diagnosis.
    Last edited by RebeccaWoodward*; 02-03-2009 at 01:01 PM.

  3. #3
    Default In Patient
    There in lies the question. When a provider does his rounds, can I use the suspected dx for icd-9 codes on that day?
    Heather Winters, CPC, CFPC

  4. #4
    Location
    Jacksonville, FL River City Chapter
    Posts
    74
    Default
    For provider-based coding, you always operate under the rule that says do not bill for probable/suspected/rule-out conditions, whether the service was provided to an inpatient or outpatient.

    Seth Canterbury, CPC, ACS-EM

  5. Smile guidelines for supspected coding
    Does the same rule appy for ICD 10 coding for suspected conditions?

  6. #6
    Location
    Baton Rouge
    Posts
    1,239
    Default
    Quote Originally Posted by Beauty23 View Post
    Does the same rule appy for ICD 10 coding for suspected conditions?
    Yes. This applies for all physician coding--cannot use suspected symptoms. This did not change with ICD10.
    Meagan Strauss, CPC, CEMC
    Coding Coordinator
    The NeuroMedical Center
    Baton Rouge, LA

  7. #7
    Location
    Columbia, MO
    Posts
    12,570
    Default
    The rule for coding uncertain diagnosis is... If you are coding for the facility you code the uncertain dx as thought it exists. However when coding for outpatient or physician coding you do not code the uncertainty. The facility rule only applies to those coding for facility reimbursement. For physician coding you always follow the physician rule regardless of the place of service.

    Debra A. Mitchell, MSPH, CPC-H

Similar Threads

  1. Definitive vs. Rule Out, Suspected, Etc.
    By suemt in forum Diagnosis Coding
    Replies: 0
    Last Post: 04-14-2015, 04:26 PM
  2. Suspected Diagnosis
    By ARCPC9491 in forum Diagnosis Coding
    Replies: 7
    Last Post: 03-12-2015, 10:12 AM
  3. dx for appendectomy/suspected condition
    By Karen A. in forum OB/GYN
    Replies: 0
    Last Post: 09-15-2014, 05:23 PM
  4. Suspected Fracture
    By sorcha48 in forum Diagnosis Coding
    Replies: 6
    Last Post: 08-19-2012, 08:16 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.